ACP Issues Recurrent Kidney Stone Prevention Guidelines
Higher fluid intake recommended; pharmacological monotherapy where fluid intake fails
MONDAY, Nov. 3, 2014 (HealthDay News) -- Increased fluid intake is recommended to prevent recurrent nephrolithiasis, with pharmacological monotherapy suggested for patients in whom increased fluid intake fails to reduce stone formation. These clinical practice guidelines were developed by the American College of Physicians (ACP) and published in the Nov. 4 issue of the Annals of Internal Medicine.
Amir Qaseem, M.D., Ph.D., from the ACP in Philadelphia, and colleagues developed guidelines on the comparative effectiveness and safety of dietary and pharmacological management of recurrent nephrolithiasis in adults. Data were collected from published literature. Symptomatic stone recurrence, pain, urinary tract obstruction with acute renal impairment, infection, procedure-related illness, emergency department visits, hospitalizations, quality of life, and end-stage renal disease were included as clinical outcomes assessed for this guideline.
The ACP recommends increased fluid intake throughout the day; recurrent nephrolithiasis can be prevented with fluid intake to achieve at least 2 L of urine per day (Grade: weak recommendation, low-quality evidence). For patients with active disease in whom increased fluid intake fails to reduce stone formation, the ACP recommends monotherapy with thiazide diuretic, citrate, or allopurinol (Grade: weak recommendation, moderate-quality evidence) to prevent recurrent nephrolithiasis.
"Increased fluid intake spread throughout the day can decrease stone recurrence by at least half with virtually no side effects," David Fleming, M.D., president of the ACP, said in a statement.